conclusion on menopause essay

About menopause - Conclusion

All women go through the menopause at some time in their life. Individual experiences of the menopause differ enormously, and how women choose to manage their menopause will depend on a number of factors including age at menopause, the presence of any symptoms and how these affect their quality of life. Risk factors for cardiovascular disease, cancer and osteoporosis will also inform their decisions. Some women prefer to take a more “natural” approach to menopause management whilst some women will choose to use hormone replacement therapy (HRT).

For all women dietary and lifestyle measures play an important part, particularly in the menopausal years: in reducing symptoms, promoting general well being, and in reducing the risks of health complications. Women should therefore ensure that they have adequate exercise and a healthy well balanced diet as part of menopause management.

To read more about Cardiovascular Disease click here

To read more about Osteoporosis click here

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Menopause and work: A narrative literature review about menopause, work and health

Petra verdonk.

a Department Ethics, Law and Humanities, Amsterdam UMC, VU University, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands

Elena Bendien

b Leyden Academy on Vitality and Ageing, Leiden, The Netherlands

Yolande Appelman

Associated data, background:.

Menopause is part of working women’s lives. In Western countries, labour market patterns are changing rapidly: women’s labour participation has increased, the percentage of full-time working women is rising, and retirement age is increasing.

This narrative literature study aims to provide an insight in the state of the art in the literature about the relationship between menopause, work and health and to identify knowledge gaps as input for further research.

The search was conducted in PubMed, CINAHL, MEDLINE and ScienceDirect. The final set includes 36 academic articles, 27 additional articles related to the topic and 6 additional sources.

Research on menopause, work and health is scarce. Results are grouped thematically as follows: Menopause and (1) a lack of recognising; (2) sickness absence and costs; (3) work ability; (4) job characteristics; (5) psychosocial and cultural factors; (6) health; (7) mental health, and (8) coping and interventions. Work ability of women with severe menopausal complaints may be negatively affected.

CONCLUSIONS:

Due to taboo, menopause remains unrecognised and unaddressed within an organisational context. New theoretical and methodological approaches towards research on menopause, work and health are required in order to match the variety of the work contexts world-wide.

1. Introduction

In Western countries, women make up half of the labour force in full- and part-time jobs [ 1–3 ]. Furthermore, labour market patterns are changing rapidly: women’s participation in the labour market has increased, the percentage of full-time working women is rising, and retirement age is increasing in many countries. As a result, a growing number of women aged 45 years and older participates in the labour market, hence, menopause is part of working women’s lives. Aim of this narrative literature study is to provide an insight in the state of the art in the literature about the relationship between menopause, work and health and to identify knowledge gaps as input for further research.

Virtually all women will go through menopause and, often, experience menopausal symptoms and complaints [ 4 ]. Given their high prevalence, symptoms can impact on women’s working lives. In a large representative Dutch study, older (> 45 yrs) and in particular highly educated female employees, reported high work-related fatigue [ 5 ]. The authors state that menopause may partly account for the unexplained differences in work-related fatigue between older highly educated men and women. To date, only few studies directly relate menopause to work, for instance to lower work ability [ 6–9 ], and show that both women and employers possess little knowledge about menopause. Employers are therefore unaware of how to contribute to a healthy working environment for female employees in this life phase, and women do not recognise their bodily signals or do not dare to ask for help [ 2 ].

1.1. Menopause and menopausal complaints

In this review, we approach menopause as a physiological process and a female-specific transitional life phase in women’s natural ageing process [ 10 ]. Menopause, perimenopause and postmenopause are stages in a woman’s life when her monthly period stops. Perimenopause is the first stage in this process and can start eight to 10 years before menopause. Menopause is the point when a woman no longer has menstrual periods for at least 12 months. Postmenopause is the stage after menopause. Already in perimenopause women can have menopausal symptoms.

There is large variation of the age, as well as dur-ation and symptoms of menopause [ 11, 12 ]. Current definitions estimate the average duration of the menopause from five to 10 years, and the average age at which the menopause occurs, is 51 years [ 3, 13, 14 ]. Furthermore, no particular set of symptoms is unquestionably ‘menopausal’, except for biomedically defined physiological symptoms which are associated with fluctuating and declining hormone levels finally resulting in the end of the menstrual cycle. Often from the mid–40s onwards, the protective effect of estrogen is lost and changes occur that lead to an increased risk of heart disease in the ensuing years. Consequently, traditional cardiovascular riskfactors are becoming more important; for instance, more than half of the postmenopausal women will develop hypertension. Furthermore, increase in cholesterol, body weight and diabetes play an important role and can be positively influenced by healthy lifestyle [ 15, 16 ]. The most commonly reported symptoms related to the hormonal changes during perimenopause are hot flashes, night sweats and vaginal dryness [e.g. 17]. Non-specific complaints related to menopause such as sleeping problems, headache, fatigue, mood changes and loss of concentration are hard to distinguish from other health problems such as stress, hypertension and burnout [ 9, 14, 18, 19 ]. Hence, complaints may be related to menopause but not recognized as such, while vice versa, non-specific complaints may be attributed to menopause while having a different cause. Confusion among women themselves as well as their health professionals can be the result [ 20 ].

1.2. Menopause as a life phase

Health complaints can occur during the menopausal transition which can last for 10 to 15 years, and changes can influence the quality of women’s lives [ 21–23 ]. Not only women themselves, but also society at large attaches meaning to menopause. Perceptions of menopause are embedded in gender ideologies, lack of understanding and stereotypes about ageing women [ 24 ]. Furthermore, different understandings of menopause are found across cultural groups. Menopause is more often viewed positively in cultures where ageing in general is valued [ 25 ]. Women’s interpretations of their symptoms depend on how ‘natural’ they are, or what their final period means to them [ 26, 27 ]. For some women, an end of physical fertility may be difficult, especially when fertility plays an important role in their identity as a woman. Ayers et al. conducted a systematic review to study the cultural, social and psychological context surrounding menopause, and reported that women who perceive menopause negatively, experience more complaints [ 24 ]. However, cause and effect remain unclear. Menopause and midlife can be problematic for women, but they can also be a turning point, after which women experience more focus and room for careers and self-development [ 26 ]. Dennerstein et al. showed that life events, daily activities, family life and job satisfaction all affect the mood of women during menopause [ 28 ]. Besides midlife is often characterised by age-related health problems and complaints, having adolescent children or becoming empty nesters, suffering from bereavement after the loss of parents, or providing informal care, a task still mostly assigned to women [ 2, 20, 29 ]. Disentangling menopause from other phenomena related to the life course, is challenging for women themselves, but also for occupational health physicians and other specialists and professionals, and for supervisors at work.

1.3. Complex interconnections

Women’s bodily experiences and biological changes interact with the social and cultural context, such as work, in which women’s lives are embedded. This complicates the study of the biological phenomenon of menopause from a psychological or sociological perspective [ 9 ]. According to Dillaway, a holistic view of menopause is important for adequate treatment of menopausal complaints [ 11, 30 ]. She illustrates how women, doctors and researchers define and describe menopause mainly in terms of chronological age. However, age- and time-bound characterisations are insufficient. When health care professionals and women themselves do not recognize menopause as a life phase, for instance because they confine themselves to a certain age category to indicate menopause, negative consequences may occur: it may limit recognition and treatment options, influence complaints that women experience and undermine women’s confidence in their own bodies, which in turn can lead to a feeling of insecurity, to suboptimal treatment or delay in adequate treatment and influence quality of life. This leads us to the following research questions:

• 1. What is the state of the art in the literature about the relationship between menopause, work and health?
• 2. Which knowledge gaps can be identified?

In this literature review, we conducted a narrative analysis and covered a broad range of topics by using studies of various complexity and design [ 31 ]. Our search was conducted between December 2018 and February 2019 in the databases PubMed, CINAHL, MEDLINE and ScienceDirect, originally using the MeSH terms ‘menopause AND work’. Our choice for the MeSH terms instead of the author’s key words was deliberate, because MeSH terms are assigned by the database specialists and function as stronger identifiers of the content. MEDLINE is a subset of PubMed, but given the low rate of the search hits found in PubMed we decided to include the searches in both databases as MEDLINE (1946) is older than PubMed (1996). This strategy resulted in many doubles, which were deleted during the fourth step of the search process. Inclusion criteria were the English language, empirical research and review articles to contextualise our findings. We screened articles and excluded those with an exclusionary medical content (see Fig. 1 Flowchart).

Flowchart of empirical studies and reviews.

We excluded articles based on our selection criteria. We deleted doubles, after which two researchers checked abstracts of remaining articles. Finally, we analysed the subset of 36 articles (see Appendix). Selected articles have been read by at least two researchers. Notes have been compared and arranged thematically.

Besides these 36 selected articles, we used another 27 articles in our results section to contextualise and interpret our findings. Additional articles were found through snowballing, including in selected articles’ references, and were included when they helped to contextualise the findings. In these studies, the relationship between menopause and work was often secondary or marginal. A few sources were found via Google, e.g. union surveys.

3.1. Not recognizing menopause

Both women and employers hardly receive information or training on menopause and thus, lack the knowledge about menopause-related health complaints and their impact on work [ 25, 32 ]. According to Fenton and Panay, this is out of balance when compared to the attention and support for pregnancy (leave) [ 33 ]. Female workers report a need to discuss menopause and break taboos surrounding menopause in the workplace. Often, women either do not see the opportunity or fear to discuss menopausal complaints and how they may affect their job performance [ 8, 25 ]. They fear speaking of menopause, in particular women in higher positions, for being ridiculed, stereotyped and stigmatised [ 2, 33 ]. Hammam et al. found that adverse (physical) working conditions (e.g. no ventilation, inflexible working hours, no possibility to change workload or tasks) were related to increased health complaints among postmenopausal women [ 34 ]. Discussing this with supervisors was uncommon, because of a lack of opportunity or time, or social and cultural barriers. According to Hardy et al., an open culture and a supervisor with basic knowledge about menopause facilitated the conversation about menopause and work, while supervisors’ gender (male), male dominance in the workplace, stigmatisation, fear, discrimination and shame were mentioned as barriers [ 35 ]. In the communication itself, being understanding, jointly looking for solutions and an empathic sense of humour were important, whereas not being taken seriously was felt as a barrier. Education and training programmes for women themselves are important and may help to diminish menopausal complaints [ 36 ].

3.2. Menopause and sickness absence and costs

A few studies focused on the relationship between menopause, absenteeism and productivity loss and costs. Geukes et al. state that three quarters of symptomatic menopausal Dutch women looking for professional help because of health complaints, has an increased risk for sickness absence, and possibly even for early withdrawal from the labour market [ 1 ]. Other studies report that menopause is associated with lower work productivity and short-term sick leave, and hence, with increased (indirect) costs for employers and for health care (direct costs) [ 23, 37–39 ]. In particular, insomnia and depression among women with menopausal complaints were associated with productivity loss and higher costs [ 40, 41 ]. Possibly, not all women report the ‘real’ reasons for sickness absence or taking a day off [ 8 ]. The evidence is however inconclusive. In Hardy et al.’s electronic survey no significant association was found between menopausal status and work-related outcomes such as sickness absence, job performance and turnover intention [ 42 ]. Further research is warranted.

3.3. Menopause and work ability

High and Marcellino reported that menopausal symptoms, in particular irritability and mood changes, negatively impacted on the job performance of older female employees, although less so for women in managerial positions [ 43 ]. In their early studies, Ilmarinen et al. en Tuomi et al. have developed the ‘Work Ability Index’ (WAI), an instrument to assess work demands in relation to the worker’s health and resources [ 44–46 ]. They concluded that for older employees, men and women, work adaptations should balance physical and mental job demands, and advocated for research on the potential influence of menopause on work ability. This has been done recently by Geukes et al., who studied healthy working women, representative of the Dutch female population, and showed that women’s physical and psychological menopausal complaints were associated with lower work ability, which increased the possibility of sickness absence [ 7 ]. The authors concluded that the women had a relatively low level of vasomotor symptoms (VMS) and that these complaints did not negatively impact on their work ability (see also [ 47 ]). More recently however, other researchers reported that VMS were the most frequently reported complaints with a negative effect on work [ 6 ]. In Jack et al.’s study, women reported that menopausal complaints negatively affected their motivation and commitment to work and increased turnover intention or intention to leave the labour market altogether [ 32 ]. In another study, women themselves directly related lower job performance to their menopausal symptoms. They tried to hide their health complaints from colleagues and supervisors by working harder to compensate for lower performance [ 8 ]. More recently, Geukes et al. concluded that the risk of reporting low work ability is eight times higher among women who report severe menopausal complaints (including VMS, physical and psychological symptoms), than women who do not report menopausal complaints [ 1 ].

3.4. Menopause and job characteristics

Generally, work improves women’s mental well-being, since it positively affects self-esteem, health and diminishes psychological stress [ 1, 14, 48 ]. Work contributes to women’s quality of life, in particular during midlife: the task of ‘raising children’ is (almost) fulfilled, so there is more room for work and self-development [ 3 ]. Job characteristics play an important role in health, in particular autonomy and support. For instance, Bariola et al. found that support from the supervisor, fulltime work, the possibility to regulate temperature in the workplace and autonomy were associated with fewer symptoms [ 49 ].

Some studies associate women’s job characteristics with cardiovascular disease, sleeping problems, VMS and depressive symptoms [ 14, 50–52 ]. In a Lithuanian case-control study with women who had suffered from myocard infarction, Malinauskiene and Tamosiunas (2010) studied the relationship between menopause, cardiovascular risk and job characteristics [ 53 ]. Controlled for socioeconomic position, menopausal women with the lowest autonomy at work had the highest cardiovascular risk, while those in the second and third quartile had a step increased risk. Evolahti et al.’s longitudinal study on the effects of psychosocial job characteristics on menopausal women’s cholesterol levels found that autonomy at work was an important predictor of healthy cholesterol levels [ 54 ]. Such results challenge us to take a broader view on the relationship between menopause and work ability, job performance and sickness absence.

3.5. Menopause and psychosocial and cultural factors

Sarrel reported a relationship between menopausal health complaints and mental well-being, since menopausal complaints can be experienced as a source of insecurity, anxiety and shame [ 9 ]. Hot flashes in particular are experienced as problematic in the workplace, because they have an impact on women’s self-confidence, harming a desired professional image, especially for women with demanding jobs and responsibilities [ 8, 33, 55 ]. Besides the association between VMS and work ability, Gartoulla and colleagues found that other factors such as overweight, financial insecurity, being single and having informal care responsibilities are associated with work ability and well-being [ 6 ]. According to Griffiths et al., having to hide menopausal complaints can become a stressor in itself [ 8 ]. Studies show that experienced stress can increase menopausal complaints [ 9 ]. Smith and colleagues suggest that the menopausal women’s assumptions about others’ reactions to hot flashes, may be more negative than is actually the case [ 56 ]. The respondents explained visible hot flashes and sweating among menopausal women by other factors, such as health problems, emotions, physical exercise, temperature, etcetera. Hence, the women’s own mindsets and convictions about menopause deserve more attention in research.

Jack et al. analysed the embodied experiences of women in relation to their work at Australian universities and identified three time-related themes [ 57 ]. First, some women described menopause as a ‘period of time’: menopause could be a time for reflection, a time for a second chance and renewed ambitions, or a time when women put the organisation where they work in ‘its place’ and put themselves central. Second, some women described menopause rather as a ‘spiral’, since their bodily experiences during menopause were not in line with time, as required by the organisation: unpredictable hot flashes or severe menstruations that require regular toilet visits create confusion and discomfort during travels, planned meetings, or education activities that were planned months in advance. Small tokens of appreciation and recognition, such as access to ventilated places, make women feel more relaxed at work, while denial of their experiences aggravate physical symptoms. And third, new alliances developed around menopause –with mothers, colleagues, supervisors, the organisation itself. New meanings were created about relations among women, in which silence about menopause was loudly heard in the realisation of shared physical experiences. The women reflected on the past, looked back at their mothers’ lives, but also at their future: how to maintain one’s position in the labour market until the retirement age, and what they need to achieve it.

3.6. Menopause and health in relation to work

A vast amount of research focuses on menopause and health problems, such as the relationship between depression and VMS [e.g. 22]or sleeping problems, which can affect women’s work [e.g. 58]. Malinauskiene and Tamosiunas studied the association between menopause and cardiovascular risk profiles among working Lithuanian women [ 53 ]. They concluded that smoking, alcohol consumption and other psychosocial factors must be incorporated when developing cardiovascular risk profiles for menopausal women. Some evidence exists about a relationship between depression, sleeping problems and night sweats, but the mechanisms behind this relationship are unclear [ 14, 52 ]. Worsley et studied the association between moderate to severe VMS and moderate to severe depressive symptoms, using data collected by Gartoulla et al. [ 6, 59 ]. Moderate to severe VMS were independently associated with depressive symptoms, after controlling for age, BMI, relationship status, education, job status, informal care, the financial and living situation and the use of Hormone Suppletion Therapie (HST).

One of the few longitudinal studies by Woods and Mitchell describes women’s experiences over the course of 18 years regarding interference at work and interference in social relations in relation to age, menopausal status, experienced stress, cortisol levels, self-reported health, as well as variety of menopausal symptoms such as hot flashes, sleeping problems, depressive mood and memory loss [ 19 ]. The influence of the symptoms on work (experienced interference) and on relations, was assessed by analysing observations collected in menstrual calendars, annual health reports, morning urine samples and symptom ratings from diaries. First, Woods and Mitchell conclude that good self-reported health is associated with less interference of menopausal symptoms at work [ 19 ]. This is also the case for self-reported stress, but not for cortisol levels. Concentration problems and a depressive mood influence both work and social relations at work, even when self-reported health and self-reported stress are accounted for. The main symptoms that interfered with work and social relations were a depressed mood and difficulties with concentrating. Menopause itself does not interfere heavily with daily life, according to the researchers.

3.7. Menopause and mental health: stress, fatigue, and burnout

In their longitudinal study, Mishra and Kuh pointed out that job stress is one of the main risk factors for lower quality of life among menopausal women [ 21 ]. Gujski et al. studied job stress in relation to cognitive functioning (aspects of memory, psychomotor speed, reaction time, complex attention, cognitive flexibility, processing speed etc.) among Polish peri- and postmenopausal female intellectual workers and found correlations between the cognitive functions and the stress-inducing factors at work [ 60 ]. The social contacts at work, a lack of rewards and support and the psychological load due to complexity of work were the main reasons for stress. Especially among women in postmenopausal period negative correlations were found between the majority of the cognitive functions and intensity of stress, and the majority of stress-inducing factors.

Matsuzaki et al. looked into the association between menopausal symptoms and job stress among Japanese nurses aged 45–60 years [ 61 ]. Most nurses reported less energy, irritability and concentration problems. Nurses in managerial positions felt unhappier and cried more often. They reported that the stress they experienced was related to overburdening at work. This indicates that differentiating between professions and functional levels is useful.

Verdonk et al. studied the prevalence and determinants of the need for recovery after work among Dutch employees. In particular, highly educated women aged 50–64 reported a high need for recovery, which was associated with working conditions, including high job demands and low autonomy in combination with lower self-reported health [ 5 ]. Chronic stress or long-term work-related fatigue can result in stress or burnout [ 20 ]. Health complaints associated with burnout can be similar to health complaints associated with menopause: fatigue, sleeping problems, cognitive problems such as concentration problems and memory loss, rumination and emotional problems such as irritability and emotional instability. Such health complaints are non-specific, are associated with high job demands and problems related to work, whereby long-term fatigue or exhaustion are the main issue. Chronic fatigue is also associated with other (severe) health complaints. Menopause and burnout are easily confused, by women themselves and by health professionals, which delays adequate health care [ 11 ].

3.8. Menopause and coping and interventions

3.8.1. individual coping strategies.

Various individual coping strategies are described in the literature [ 2, 8, 33 ]. For sleeping problems and possible consequences, such as fatigue, solutions are not simple. Coping with hot flashes is often resolved by bringing extra clothes, dressing in ‘layers’, or bringing along a (mini) fan. Sometimes, windows can be opened, or women refresh themselves in bathrooms. Strategies for concentration problems or forgetfulness are for instance double checking one’s work or making to do lists. Adapting tasks or changing work schedules are also mentioned. Other coping strategies, more lifestyle-oriented, are changes in diet, (extra) exercise or sleeping extra hours [ 2, 8, 33 ].

The use of humour or talking about menopause with other people is mentioned least often by women themselves [ 8 ]. Less beneficial coping strategies that some women use, are for instance working extra hard in order to make up for the ‘shortcomings’ that result from menopausal complaints, compensating hours or hiding these ‘shortcomings’, taking sick leave or holidays without mentioning the real reasons [ 2, 33 ]. In short, strategies directed at adjustment in the workplace and openness seem to be used less often than strategies that focus on coping with or diminishing the complaints.

3.8.2. Interventions aimed at women

HST is a contested issue, because it raises questions regarding contraindications or a lack of clarity about the long-term health effects [ 62–66 ]. More and more attention has been paid to non-hormonal treatment in order to diminish VMS or depression, such as lifestyle interventions e.g. diet or non-hormonal medication [for an overview see 67]. Cognitive and behavioural therapy and mindfulness-based therapy continue to play a role in the treatment of health complaints related to menopause, in particular to depressive symptoms [ 68, 69 ]. Few studies associate therapeutic support with women’s work ability. In 2016, Hunter et al. published a study protocol for a randomized controlled trial to study the effects of a self-help intervention based on cognitive behavioural therapy for menopausal complaints [ 70 ]. They expected that diminishing VMS and night sweats would lead to less sickness absence and presenteeism, lower job stress levels and turn over intention, and higher job satisfaction and productivity. The intervention consisted of a four-week programme based on psychoeducation, relaxation and breathing exercises, cognitive exercises and other suggestions. Results were published in Hardy et al.’s later study, which indeed showed a positive effect of cognitive behavioural therapy on VMS and night sweats as well as on job performance, and a negative effect on presenteeism [ 71 ].

In a retrospective cohort study, Geukes et al. stu-died the relationship between (improvement of) severe menopausal symptoms and work ability among working women [ 72 ]. The women, who visited a menopause clinic for the first time, were followed for 3–9 months. First, they were offered an intervention consisting of a 60-minute intake about menopausal symptoms and lifestyle with a specialist nurse, a consultation with a gynaecologist to support decision-making about treatment and a short follow-up consultation with the gynaecologist. In the following 3–9 months, a second consultation took place with the nurse. Most women reported improved work ability during follow-up, and all women reported fewer complaints. In the Finnish study, Rutanen et al. looked into physical exercise and its effects on i.a. women’s work ability [ 73 ]. After six months of aerobics training, the participating women showed improved mental health outcomes and decreased physical demands compared with the control group, but no differences in WAI scores. Studies of such interventions are scarce.

Ariyoshi conducted an evaluation study (survey and case study) among female journalists, administrative and sales representatives who worked or had worked for a Japanese media company [ 74 ]. Women’s menopausal complaints were the reason to participate in the study. Data about consultation with a nurse, three case studies, and the number of sick days related to menopause were collected and assessed. After the intervention, sick leave related to menopause had diminished, as well as turnover. The study showed that a specialist nurse and human resource management can play an important role by developing and offering tailored interventions for working women going through menopause.

3.8.3. Interventions aimed at the workplace

The British UNISON’s (The Public Service Union) guide to menopause states that menopause is too often considered to be a private issue instead of an occupational health issue [ 75 ]. According to UNISON, employers should realise that women going through menopause may need special support to continue working and be productive [ 75 ]. Griffiths et al. state that at least four issues need to be addressed [ 8, 76 ]: (1) awareness among supervisors that menopause can cause problems at work, (2) flexible schedules, (3) access to information and resources, and (4) temperature and ventilation at work. According to Fenton and Panay, offering awareness training to supervisors can be useful [ 33 ]. They emphasise the importance of a positive attitude and organisational culture, which offers a safe environment for women to address menopausal complaints. There should be options to talk with a confidential advisor, preferably a female colleague with experience, because women feel uncomfortable addressing these issues with their (male) supervisor [ 2 ]. These authors advocate for flexible sick leave procedures in case of menopausal complaints, and warn against the negative consequences of sick leave. Policies directed at taking (extra) breaks or leaving early when menopausal complaints occur, are also suggested as improvements of a sustainable working environment that takes menopause as a phenomenon seriously [ 33 ].

Hickey et al. studied the relationship between menopausal symptoms as measured with the Menopause Rating Scale (MRC) and work-related outcomes such as job performance, frequency of mistakes, autonomy and turnover intention [ 14 ]. Symptomatic women received a number of suggestions for possible support. Addressing temperature control, flexible hours, seminars about healthy ageing, flexible work spaces, physical exercise programs and table fans were the most attractive to the participants. Organisations benefit from policies directed at healthy ageing, and the working environment must be designed to not exaggerate menopausal symptoms. Furthermore, specific needs of women in menopause deserve attention in risk-inventories and evaluations.

Studies show that menopausal complaints are affected by situational factors and can be aggravated by the work environment [ 8, 13, 42 ]. Hardy et al. studied female employees’ perspectives on their employers [ 13 ]. For some women it was difficult to deal with menopause in the workplace, partly due to aspects of the work environment such as lack of knowledge or awareness among colleagues, a lack of communication skills among employees and employers and the lack of organisational policies. This was in line with other studies, and organisational policies for women in this stage are helpful [ 2, 13, 14, 76–78 ].

Hardy et al.’s recent work describes a first attempt to address difficulties with talking about menopause [ 79 ]. In their study, the supervisors of three large British organisations (one public and two private) received a 30-minute online training with the aim to raise awareness, increase knowledge and improve attitudes towards menopause, and to develop their skills in communication about menopause with employees. Most of the trainees would recommend the training to colleagues.

4. Discussion

4.1. state of the art.

Menopause in relation to work is hardly studied, but the number of studies is increasing [ 4, 77 ]. The first cautious conclusions from our findings are: (a) menopause can play a role in diminished work ability of women in this life stage but evidence is inconclusive; (b) menopausal complaints could be a likely explanation for older women’s higher sickness absence rates; (c) women with menopausal complaints continue to work (presenteeism), and (d) women remain silent about their menopausal complaints (taboo) and seek individual solutions to cope with work.

In particular, work ability among women with severe menopausal complaints may be negatively affected [ 1 ]. Negative consequences of diminished work ability are sickness absenteeism, turnover intention and other health related issues. At the same time less favourable working conditions, such as the lack of job autonomy or a lack of control over the physical working environment, seem to negatively affect menopausal complaints [ 42, 49 ]. Women use several individual strategies to cope with menopausal complaints at work which can be more (healthy lifestyle changes) or less adequate (working more hours to make up for lower productivity). Such interventions at an individual level (self-help interventions) and at the workplace (e.g. educating supervisors) could be successful. They are positively valued, by women themselves and also by supervisors [ 8, 71 ]. Menopause is hardly discussed in the workplace, which is related to the taboos surrounding menopause, as well as to the lack of knowledge by the women themselves, health care professionals and employers [ 35, 79 ].

Organisational policies about menopause and work are hardly described. Further stigmatization of (older) women needs to be avoided when menopause at work and its taboo are being addressed –a leap from women’s work-related health problems to women themselves being a problem is easily made. We conclude that menopause is rather seen as a woman’s individual problem than as an organisationally and societally relevant issue. The lack of knowledge about the relationship between menopause, work and health directly affects women’s health as well as their position in the labour market, since they are not offered workplace interventions or professional support. Individual solutions of women can (continue to) lead to diminished well-being at work and eventually to distancing from or leaving the labour market altogether [ 40 ]. However, work is essential not in the least for women’s economic independence also in midlife and in old age. For both men and women, work is a source of self-fulfilment, health, self-development, self-confidence, and empowerment [ 80 ]. However, the lack of attention for menopause in research and organisational policies gives the impression that older women’s work and health are taken less seriously and are found less important. We conclude that the resilience of working women in this life stage is very high, but it is put under pressure in times of increasing intensification of work, an ageing labour market population and labour market shortages. Good health is important for women’s sustainable employment and a dignified life during retirement, but also for the work organisation and society as a whole. Menopause in relation to work requires serious consideration, both in research and policy at all levels.

4.2. Knowledge gaps and directions for new research

Based on this literature review we identified several knowledge gaps.

First, we need to understand why a topic that is relevant to (almost) all working women is systematically being ignored in research and in organisations. Women’s health issues such as menopause and reproductive health, breast cancer or endometriosis, but also sexual or intimate partner violence, are major public health matters [ 81 ]. Gender bias in medicine has been described for decades already and women’s health advocates have called for integration of women’s health in research agendas and curricula [ 81 ]. Our review indicates that epistemic injustice in organisational and health research is still effectively in place. The taboo on menopause that is referred to in studies is reinforced by women themselves, but this takes place in a context which values (women’s) youth over midlife, mind over body and productivity over reflection [ 82 ].

Second, menopause must be studied in relation to: (a) physical working conditions, such as temperature and ventilation, but also nightshifts, working with chemical substances and physical requirements such as heavy lifting, and (b) health issues later in life. In order to provide women with the opportunities to live up to their potential, we need to know how psychosocial working conditions, such as coping with menopausal complaints at work, or the relationship between menopausal complaints and job demands and job autonomy, or social support, are associated with menopausal complaints and with health problems such as cardiovascular conditions later in life. At organisational and policy level, it is important that we understand how organisations and work can be designed in ways that support sustainable employment of women in this life stage, including women with severe menopausal complaints.

Third, we need comparative studies about the relationship between menopause and work across professions and sectors, but also across cultures. Most of the incorporated studies concern women who work in education and health care, or conduct administrative work, which reflects gender segregation in the labour market [ 80 ]. However, specific studies are required on the health and experiences of women during menopause, not just in the ‘female-typed’ sectors, but also in sectors where women represent a minority such as the military, the police force and the industry [ 83 ]. Being member of a minority group may bring about even more complex issues regarding menopause and health. In this respect we point for instance towards Gnudi et al.’s work, in which the authors explore the relationship between lifelong physical job demands and retired women’s lower back pain [ 84 ]. The study was not included in this review, because the relationship between work and health is only indirectly related to menopause. However, the authors did address professions that were characterised by heavy physical job demands (carrying, pushing, lifting heavy weights) in sectors where women work, such as farming, ceramics and glass industry, paper production and steel industry. In our review, we only found few examples of studies that associated menopause with a particular profession, such as Ilmarinen et al.’s study [ 44 ]. In a small number of studies such as Ariyoshi’s study or Cau-Bareille’s study about the motivations of female kindergarten teachers for early retirement, attempts were made to connect experiences with menopause to (quitting) work [ 74, 85 ]. However, these were small studies. Chau et al. searched for studies on night shifts and women’s reproductive health in CINAHL, MEDLINE and other databases using the search terms ‘shift-work’ and ‘female/women’[ 86 ]. They identified 20 articles related to pregnancy, fertility and the menstrual cycle and zero results related to menopause and work. We support their urgent call to critically evaluate research agendas regarding changing labour market demographics and expected upcoming labour shortages. Breast cancer in women has been studied in relation to night shifts [ 87 ]. Other research could focus on wearing uniforms in relation to hot flashes, negative stereotypes that hamper women’s functioning and exclusion of women in ‘typical male’ environments, or the intersection of sexism and ageism towards working women during menopause. Comparative intercultural studies are lacking as well. In 1996, Kaufert already wrote that studies on menopause conducted outside of the United States or Europe, often use similar methodological research designs, whereas the cultural, economic and social context on other continents is very different, including the role of ageing women in societies [ 34, 88, 89 ]. Existing knowledge is to a large extent based on white, middle class, urban and mostly healthy women. Research methods and recommendations for practice require accommodation to multicultural societies.

Fourth, there is a need for innovative methodological and theoretical frameworks. Most available studies used instruments such as GCS, WAI, MENQOL, assessing both biomedical and psychosocial aspects of menopause. Since these domains cannot be separated, we need research instruments that do justice to the complexity of the relationship between work and menopause. Studying work and menopause is far from simple. As moving targets, menopause and menopausal complaints pose difficulties for researchers to demarcate menopause as a life stage during the life course, but also to demarcate menopausal complaints in relation to other health complaints. These complexities show the different layers of menopause as a phenomenon, the study of which requires further development of methodological and theoretical frameworks. Jack et al. address this gap and advocate for research from a feminist perspective [ 57 ]. Their study is an example of how the approach to studying menopause and work can be extended from a single biomedical endocrinological perspective (hormone fluctuations) or a psychological perspective (individual coping and self-management approaches) to a broader framework. We firmly believe that research on menopause and work will benefit from a transdisciplinary approach, preferably from an intersectional perspective [e.g. 81]. Therefore we advocate for a broader methodological framework, which incorporates the use of existing scales and instruments but also mixed-method research designs, as well as narrative, ethnographic and participatory action research designs with stakeholder and end-user approaches [ 90 ]. Participatory research is suitable to map multiple perspectives and bring about a dialogue between employers, employees and other stakeholders about experiences, problems and possibilities for support, for instance in the form of adapted HR-policies [ 91 ].

Given the many open endings, our recommendations for practice need to be taken with caution. Based on our literature review, we do recommend that: (a) awareness about menopause and work is raised among occupational health professionals, including physicians, by developing guidelines for menopause and work; (b) organisations map health problems, job characteristics and sickness absenteeism in relation to female-specific life stages, and (c) a broad awareness raising programme about menopause at work is developed for employers, employees and the public at large.

4.3. Strengths and limitations to the study

A main limitation to the review is the small number of available studies. That is why we incorporated studies of all qualities, which affects the robustness of our findings. Authors tend to refer to each other, which poses the risk that conclusions from a single study are generalised and exaggerated. Available studies are often based on known scales and instruments, often self-report, such as the WAI, and used in Western settings, but not necessarily validated for women in menopause and not validated cross-culturally. The results of the studies usually only indicate the possible negative effects of certain physical symptoms such as VSM and sleeping problems, and of certain psychological symptoms such as stress, anxiety and shame, on women’s work ability and their well-being. Positive aspects of menopause and ageing in relation to work are not studied. Furthermore, these instruments do not necessarily tap into women’s lived experiences. Other types of research may provide insight in women’s embodied experiences in this life stage within the context of women’s lives.

5. Conclusion

Our review is one of few literature studies on menopause, work and health [ 77 ]. Even though the number of studies on the subject has been increasing during the past years, we still consider the scarcity of studies on menopause, health and work as an epistemic gap. Our critical stance does not diminish the relevance of the studies that were conducted during the past 20 years, and the outcomes of the pioneering studies incorporated in this review help us move forward and stimulate further research. The resilience of working women in this life stage is very high, but under pressure. Good health is important for women, for the work organisation, and for society as a whole. Menopause in relation to work requires serious consideration, both in research and policy at all levels.

This study was funded by WOMEN Inc. and Instituut GAK (2018-2019).

Conflict of interest

None to report.

Supplementary Material

Supplementary material.

The appendix is available from https://dx.doi.org/10.3233/WOR-205214 .

Women's experience of menopause: a systematic review of qualitative evidence

Affiliations.

• 1 University of São Paulo.
• 2 The Brazilian Centre for Evidence-based Healthcare: a Collaborating centre of The Joanna Briggs Institute.
• PMID: 26455946
• DOI: 10.11124/jbisrir-2015-1948

Background: Evidence shows than an estimated one billion women have experienced menopause worldwide. The experience of menopause is influenced by beliefs and values prevalent in the sociocultural setting, the background of the women, and the ways in which the women approach changes in this phase of life. Independently of the circumstances involved, women experiencing menopause need to have their care needs and corresponding support identified based on their personal and contextual perspectives. Although it is essential to provide appropriate support to women experiencing menopause, no systematic reviews have so far been conducted that focus on menopause experienced by women worldwide.

Objectives: The objective of this review is to identify the best available evidence related to how women experience menopause worldwide.

Types of participants: This review considered studies that included menopausal women aged between 40 and 65 years, who have lived the transition from reproductive years through menopause and beyond. This review included only studies whose participants have lived the experience of natural menopause. Women who have had induced menopause, or with premature menopause were excluded from this review. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: This review considered studies that investigate women's experiences of natural menopause under the scope of different social and cultural settings. TYPES OF STUDIES: This review considered studies that have a descriptive and interpretive approach, conducted using qualitative methodology. Qualitative studies that focus on program evaluation were excluded from this review. Qualitative data including, but not limited to, study designs such as phenomenology, grounded theory, ethnography, action research and feminist research were considered for inclusion in this review. TYPES OF OUTCOMES: This review considered studies that include the following outcome measures: all aspects related both directly and indirectly to the experience of menopause, as concretely lived by women and according to their own point of view.

Search strategy: The search strategy aimed to find both published and unpublished studies. Studies published in English, French, Portuguese and Spanish were considered for inclusion in this review, without any restriction in terms of year of publication. This decision was made to permit the inclusion of all of research related to women's lived experiences of menopause worldwide since the inception of this type of research. The databases searched included CINAHL, Medline and Pubmed, PsycINFO, Lilacs, Scielo, Scopus, Dissertation Abstracts International and the University of São Paulo Dissertations and Thesis.

Methodological quality: Each primary study was assessed by two independent reviewers for methodological quality. The Joanna Briggs Institute Qualitative Appraisal and Review Instrument Data Extraction Form for Interpretive and Critical Research was used to appraise the methodological quality of all papers.

Data collection: Qualitative data was extracted from papers included in the review using standardized data extraction tools developed by the Joanna Briggs Institute.

Data synthesis: Qualitative research findings were synthesized using The Joanna Briggs Institute Qualitative Appraisal and Review Instrument.

Results: From the 24 included studies, 108 findings were extracted. These findings were aggregated into 17 categories, and then into six synthesized findings. The six synthesized findings are: (i) Menopause is a natural event in a woman’s life that is closely associated with psychosocial events of midlife and the aging process; (ii) The physical and emotional changes of menopause strongly affect the women; (iii) The women perceive menopause as a time characterized by gains and losses; (iv) Resilience is improved at the time of menopause and coping strategies are adopted to enhance physical and emotional wellbeing; (v) Health issues, family and marital relations, sociocultural background and meaning attributed to the women’s sex life determine if the sexual experiences during menopause are pleasant or not; and (vi) The women should be prepared and have their needs supported according to their perspectives.

Conclusions: The systematic review shows that menopause is a stage of life experienced in different ways. The experience of menopause is characterized by personal challenges and changes in personal roles within the family and society. Hot flushes and night sweats are the strongest symptoms of those reported by women affected by the changes experienced during menopause. The positive or negative ways in which each woman approaches the changes during menopause are influenced by their personal, family and sociocultural background. Health care providers pay little attention to women´s perceptions regarding menopause. Considering menopause is a time when women feel vulnerable, personal and tailored healthcare according to individual needs, preferences and expectations should be provided. Coping strategies regarding the effects of menopause should be determined in creative and dynamic ways through the identification and consideration of the complex issues involved. These measures are essential to ensuring effective support for menopausal women.

Keywords: Menopause; change events; life experiences.

The Joanna Briggs Institute.

Publication types

• Research Support, Non-U.S. Gov't
• Systematic Review
• Anthropology, Cultural
• Cultural Characteristics
• Global Health
• Health Knowledge, Attitudes, Practice*
• Menopause / physiology
• Menopause / psychology*
• Middle Aged
• Postmenopause / physiology
• Postmenopause / psychology
• Qualitative Research

Menopause and Associated Anatomical Changes Essay

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

Introduction

Menopause is associated with several changes, which may be anatomical, physiological, and hormonal. Menopause is characterized by a reduction in the production of certain hormones, such as estrogen and progesterone, which affect the anatomical structure of organs such as the uterus and ovaries. After menopause, fertility ends, but women can continue living healthy lives. Reproductive functions are associated with hormones indicating that changes in hormone production levels can affect the anatomy of some body parts. It is estimated that the ratio of the body to the cervix reduces to 1:1 in a majority of women (Jee, 2021). Menopause can cause a decrease in the size of the uterus and thickness of the endometrium walls, which can be attributed to low estrogen levels.

Ovaries ease to produce eggs after menopause, making them inactive. Additionally, ovaries reduce as one ages; hence, the same trajectory is expected to continue after menopause. According to a study, ovaries shrink in size and may become wrinkled following menopause. Additionally, the cortex becomes thinner with the increased production of stromal cells, which are secretory (Jee, 2021). The fallopian tubes become atrophic as cilia and plicae disappear. The vagina losses elasticity hence becoming narrower while the vaginal epithelium thins. Some women experience atrophic features on the vulva while the labia may flatten, causing the introitus to be narrow (Jee, 2021). The bladder and urethra shrink in size and may experience dysuria or stress incontinence. Due to a loss of muscle tone, an individual may experience pelvic relations and changes in the structure of the urethra.

Generally, menopause causes a reduction in estrogen and progression, which are associated with the structure or anatomy of reproductive body parts. This affects different body organs, causing changes in anatomy such as size shrinkage and loss of elasticity. All these are effects of age, but the changes in anatomy may differ in individuals due to variations in the aspects of body function, such as the production of hormones.

Jee, K. O. (2021). Menopause and homoeopathy. International Journal of Menopause and Homoeopathy, 5 (4), 379-382.

• Endometritis and Endometriosis Symptoms and Care
• Morphometric Study of Ovarian Follicle Growth and Ovarian Surface Epithelium During Pregnancy in the Rat
• Diagnostics: Itching and Burning in the Vagina
• Metabolic Responses to Exercise
• Meiosis and Mitosis and Mendel’s Law of Independent Assortment
• The Human Body as a Site of Active Conflict
• Biology: Analysis of Egg Experiment
• Operant and Respondent Conditioning
• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2023, August 21). Menopause and Associated Anatomical Changes. https://ivypanda.com/essays/menopause-and-associated-anatomical-changes/

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IvyPanda . 2023. "Menopause and Associated Anatomical Changes." August 21, 2023. https://ivypanda.com/essays/menopause-and-associated-anatomical-changes/.

1. IvyPanda . "Menopause and Associated Anatomical Changes." August 21, 2023. https://ivypanda.com/essays/menopause-and-associated-anatomical-changes/.

Bibliography

IvyPanda . "Menopause and Associated Anatomical Changes." August 21, 2023. https://ivypanda.com/essays/menopause-and-associated-anatomical-changes/.

FEMINIST GIANT

Essay: The Power and Glory of Menopause

Pictures: Birgitte Nyborg, Mike Kollöffel / Netflix; Nicola Sturgeon, Manuel Vazquez/The Guardian

Nicola Sturgeon is not the first woman to lead a country. But it is telling that the only other cis woman leader that she can compare her experience of the menopause transition with is fictional. Because other than Sturgeon and Danish TV series Borgen’s Birgitte Nyborg, you would think that being elected into office rendered female political leaders immune from a life transition that affects everyone who has ever had a uterus.

Last Tuesday was World Menopause Day. I had wanted to publish this essay then, to praise Sturgeon’s openness and lament the silence of too many others. But I decided to wait to see if any other woman political leader would develop ovaries of steel, prove me wrong, and add her voice to Sturgeon’s. 

And so here we are, with only Sturgeon, the 52-year-old First Minister of Scotland in real life, and Birgitte Nyborg as her counterpart in drama, talking about hot flashes, anxiety, rage, insomnia and other ways that going through the menopausal transition is affecting them. But even in Borgen, that conversation is between Nyborg–former fictional prime minister and now fictional foreign minister and fictional leader of her fictional party–and her (fictional) doctor. 

Sturgeon has been telling the whole, real world. 

And her truth preceded and is braver even than Nyborg’s fiction. Before the fourth season of Borgen even began in June–showing us Nyborg in the very first episode rushing out of a meeting to recover from a hot flash in the bathroom–Sturgeon had discussed with writer and broadcaster Sam Baker what she would do were she to experience a hot flash (known as hot flush in the U.K.) during a work meeting.

“I would like to think I would be open about it. If you look around the world, there’s not been that many women leaders … I guess Angela Merkel must have gone through it when she was in office, Hillary Clinton … so if you’ve got that platform, then I would like to think I would use that positively, but I’m also a human being,” Sturgeon said in January on Baker’s The Shift, a podcast that “aims to tell the truth about being a woman post-40.” (Full disclosure: I’ve also had the pleasure of being a guest of this fantastic podcast.)

Sturgeon said she had not at that time yet experienced hot flashes at work, but that she was “definitely at the stage of feeling hotter overnight, not being able to sleep and all that sort of thing”.

“So I’ve got windows open in the depth of winter, my poor husband is shivering. I’ve thought to myself: what if that happens when I’m on my feet in parliament in the middle of First Minister’s questions? What would I do? That could happen any time. I’m not sure I will know the answer to that question until it happens,” she told Baker. 

And then in June, Sturgeon opened #FlushFest22–a festival about all things menopause–with a conversation with broadcaster Kirsty Wark in which the First Minister said she had been on Hormone Replacement Therapy for the past four months.

“I think (it) has helped. I’ve not been as rage filled,” Sturgeon said, laughing. “I’m sleeping better. That’s the main difference it’s making.”

Bloody Hell! Adventures in Menopause

And, after Wark remarks that when former British Prime Minister Margaret Thatcher used to say she dealt with the job on five hours sleep, that she was probably menopausal, Sturgeon again lamented the silence of the actual women who preceded her.

“This is one of the reasons why I’m talking about it…There are very few women who’ve been in top positions in politics, but of those who have been, if you think about Angela Merkel, Hillary Clinton, Thatcher they must all have gone through this,” Sturgeon said. “And yet I can’t find anybody that has spoken about it and that would help me, I think, if I could go and hear or read somebody who had the same kind of anxieties that I have about the very public nature of the job.”

Let’s take a look at some of Sturgeon’s predecessors.

Indira Ghandi was 49 when she became India’s prime minister in 1966; Margaret Thatcher was 54 when she was elected prime minister of the U.K. in 1979; Angela Merkel was 51 when she became chancellor of Germany in 2005, to name just three. Their age during their term in office indicates they probably did indeed go through the menopause transition while leading their countries, but none of them, publicly at least, said anything about it.

A quick count on Wikipedia tells me there are 30 women presidents and prime ministers currently in office around the world. And whether they are perimenopausal or postmenopausal or still have a few years before they are in either stage, it is telling that none of them has publicly talked about menopause. 

And I hold out little hope that the latest additions to that roster–Liz Truss in the U.K. and Giorgia Meloni in Italy–will shatter the silence. 

Liz Truss, 47, was outlasted by a wilted lettuce and has vacated 10 Downing Street after just 44 days in office. And Meloni, 45, who campaigned on a manifesto straight out of Fascism Central–“God, homeland and family”-- is the head of the BROTHERS of Italy party for fuck’s sake. Neither the woman who has famously branded herself “I am a woman, I am a mother, I am Italian, I am Christian,” nor the “brothers” she represents are likely to take a feminist sledgehammer to the patriarchal silencing around menopause.

And so Nicola Sturgeon–who also shares with Wark how she handles brain fog and other impacts of perimenopause–has only Brigitte Nyborg to compare notes with. 

Why would it require ovaries of steel or any other metaphors of courage, to talk about a life transition that will affect more than half the population?

Even those who were not heads of state have only just recently started talking about menopause. 

In August 2020 on her eponymous podcast , former U.S. First Lady Michelle Obama, 58, described in surreal detail what it was like to go through a hot flash as she was about to climb out of Marine One. 

“I'm dressed, I need to get out, walk into an event, and, literally, it was like somebody put a furnace in my core and turned it on high, and then everything started melting. And I thought, 'Well, this is crazy. I can't, I can't, I can't do this,'" Obama told her podcast guest, Dr. Sharon Malone, an expert in menopause care.

In September 2022, on the first episode of the docuseries Gutsy that she co-hosts with her daughter Chelsea, former First Lady and Secretary of State Hillary Clinton talked about menopause with comedian Wanda Sykes, who has taken to calling her menopause belly Esther.

"After a certain age, we all seem to inherit these new things on our bodies," Hillary Clinton, 74, told PEOPLE magazine. "It was toward the end of (President Bill Clinton’s) second term, after I turned 50 in 1997, that I began to go through menopause, and it was something you didn't talk about in those days. My friends and I would talk about it or roll our eyes, but not publicly."

Hillary and Chelsea Clinton bowl with Wanda Sykes. COURTESY OF APPLE via PEOPLE

"That's why we really wanted to talk about it with Wanda, because it's a universal experience for us. Thank goodness we're getting into a time women's health — and especially now with all the challenges about reproductive health — are [sic] forcing this conversation out of the shadows and into the daylight," Clinton said.

Imagine if all the energy it takes to acquiesce to that shame around menopause and surrender to silence went into owning the power and the glory of this stage of our life. The patriarchy would quake in fear.

7 Necessary Sins for Women and Girls

It’s not as if Nicola Sturgeon invented menopause. Michelle Obama described her husband, President Barack Obama, seeing it around him. 

"Barack was surrounded by women in his cabinet, many going through menopause, and he could see it, he could see it in somebody, 'cause sweat would start pouring. And he's like, 'Well, what's going on?' And it's like, 'No, this is just how we live,' you know," she told Dr. Malone on the Michelle Obama Podcast. "He didn't fall apart because he found out there were several women in his staff that were going through menopause. It was just sort of like, 'Oh, well, turn the air conditioner on.'"

So clearly, menopause is an open secret wherever midlife cis women are. And remember it is shrouded in even more silence for trans, intersex, and nonbinary people.

I am glad that both Michelle Obama and Hillary Clinton have spoken about their menopause transition. But where is everybody else?

In the U.S. alone, you know, by looking at their age, that Representative Marjorie Taylor Greene, 48, is going through the menopause transition. As is Supreme Court Justice Amy Coney Barrett, 50. 

I could go through a whole list of lawmakers, governors, and other women in prominent political positions around the world, but you get my gist.

Imagine if all the energy it takes to acquiesce to that shame around menopause and surrender to silence went into owning the power and the glory of this stage of our life.

The patriarchy would quake in fear.

These are cis women who wield a power that patriarchy understands. Patriarchy understands political power. But for the longest time it reserved that kind of power for cis men. And for the longest time, you had to mimic cis men in order to be allowed into those hallowed halls of political power. In many cases, you still do. The kind of power that patriarchy “allowed” women, was the power it bestowed on them–of youth, fertility, motherhood. 

It is no coincidence that these women who–while not all dismantling patriarchy–wield power in the way patriarchy understands and allows for cis men–are doing so as they go through the menopause transition. But they are “losing” the power that patriarchy tolerates in cis women–youth and fertility.

For many reasons, women reach pinnacles of political power as they enter midlife–be it age requirements of certain political positions, more time because their children (if they have them) have grown, or simply because it takes years to accrue power and to make it up that ladder. 

And it is at that moment, in midlife as they accrue the most political power, that cis women also go through the menopause transition. 

That is no coincidence. Because we are finally able to seize a power that for too long we were told was off limits and it is the power of menopause–the power that menopause bestows–that propels us over those limits.

It is time for other “powerful” women in politics to also claim that power of menopause. It is time for us all to claim that power. 

But the silence around it makes it seem like it is a liability. And they know it will be used as such, as is any difference between women and men used by patriarchy to disadvantage women. Nicola Sturgeon says as much to her interviewers.

In Borgen, we see Birgitte Nyborg go on one television news show after another, to be grilled by journalists trying to push her into a confession or a revelation that would potentially wreck her career. I wonder as I watch these sparring matches, if she were ever to say on these fictional TV shows what Nicola Sturgeon has said– “I am going through the menopause transition. I am taking HRT. I have ways of handling brain fog and you might see me go through a hot flash one of these days”-- if that would do it.

If the fictional Birgitte Nyborg of Borgen were to go on television and say what Nicola Sturgeon has said in real life, would it wreck her career?

And this is what makes Sturgeon brave, although it should not be brave to talk about your body doing exactly what it should be doing and to talk about it without shame. But it is also what makes Sturgeon powerful. 

She has claimed a double form of power. She wields the power that patriarchy understands–political power–and she has claimed also the power of looking patriarchy in the eye and refusing to be shamed. She does not have children, she has “lost” the power that patriarchy tolerates in cis women and sill refuses to be vanquished. 

For too long, women in politics have had to either hide all that makes them a cis woman or flaunt all that the patriarchy most values in a woman–youth, fertility, motherhood. Look at Giorgia Meloni’s “I am a woman, I am a mother, I am Italian, I am Christian.”

Nicola Sturgeon refuses that game and in so doing has signaled she is out of the bounds of patriarchal control. Surely that is what makes us menopausal folks so terrifying. And surely that is why we have been shamed into feeling we have “lost” something. So that we don’t recognize what we have gained. 

Power. We have gained power.

“There is an upside to this stage in life where menopause can reduce women’s confidence but I think getting to this stage in life gives you another kind of confidence…‘eff it a little bit and say what you think and who cares what other people think.” Sturgeon told Wark. “There is a liberating element to all of this.”

Mona Eltahawy is a feminist author, commentator and disruptor of patriarchy. She is editing an anthology on menopause called Bloody Hell! And Other Stories: Adventures in Menopause from Across the Personal and Political Spectrum. Her first book  Headscarves and Hymens: Why the Middle East Needs a Sexual Revolution  (2015) targeted patriarchy in the Middle East and North Africa and her second  The Seven Necessary Sins For Women and Girls  (2019) took her disruption worldwide. It is now available in  Ireland and the UK . Her commentary has appeared in media around the world and she makes video essays and writes a newsletter as FEMINIST GIANT.  

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The Little Book of Menopause; Essays on the Biology and Management of Menopause

The Little Book of Menopause; Essays on the Biology and Management of Menopause  will address the role of inflammation as the underlying cause of most of the menopause symptoms, the biologic impact that loss of estrogen plays in this process and the role that hormone replacement serves to reduce these symptoms.

About the book: Considerable confusion exists among women and their care providers regarding the biology of the menopause. Once considered a one year problem for some women, (at a time when premenstrual syndrome was considered just a mood disorder) menopause is now recognized as starting in the 40s, and for some, extending into the 70s. As such, in the past decade, this important field of women’s health has emerged as factual, structured, and formal. Why do these menopausal symptoms appear? How long do they last? What is their impact on personal lifestyle and business economics? And what safe measures can be employed to modify them? In recent years scientists have contributed significant information as to the etiologies of hot flashes, mood swings, memory loss, vaginal dryness, loss of libido, bone and heart health. Yet so little of this information is known to care providers who daily must care for these challenged women as the U.S. population ages. These essays will address the role of inflammation as the underlying cause of most of the menopause symptoms, the biologic impact that loss of estrogen plays in this process and the role that hormone replacement serves to reduce these symptoms. Care providers in women’s health now have a responsibility to embrace care of the menopausal woman with the same level of professionalism as they apply to obstetrics and gynecology of younger women. Our understanding of the biology of menopause now makes that possible.

Learn more about the book

James Woods | 7/27/2016

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Alfonso Cuarón Assigned His ‘Harry Potter’ Cast Homework: Write an Essay About Your Character

Samantha bergeson.

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Alfonso Cuarón knew he wanted franchise installment “ Harry Potter and the Prisoner of Azkaban ” to be different from the other “Potter” films. So the professor assigned his Hogwarts, Ravenclaw, Slytherin, and Hufflepuff students some homework.

The director wanted the 2004 “Harry Potter” feature to have a “noir” tone, which Cuarón believed would best present the coming-of-age moment for both the trio of characters played by Daniel Radcliffe , Emma Watson , and Rupert Grint , as well as for the film series itself.

“Chris [Columbus] would help them with intonation and get them excited; Alfonso was treating them as young adults: what are you feeling?” the franchise’s producer David Heyman recalled to Total Film for a 20th-anniversary retrospective interview. Related Stories The ‘Deadpool 3’ Popcorn Bucket Is Just as Degrading to Wolverine as You’d Expect Molly Ringwald Says She Was ‘Taken Advantage of’ by ‘Predators’ as a Teen Star

Part of getting the core cast to grow up onscreen was to have each actor meditate on their respective characters’ motivations. Cuarón went so far as to assign each a writing task.

“Alfonso also had the three kids write essays about their characters,” Heyman said. “Dan wrote a page, Emma wrote 10 or 12, and Rupert didn’t give in anything. Just perfect.”

As Cuarón himself told Total Film, “Harry Potter and the Prisoner of Azkaban” was a risky move for his own career.

“The first two ‘Potters’ deal with children’s experience,” Cuarón said. “Characters who are 11 and 12. Innocence. A purity even in the way they see the danger. We were dealing with the first sting of questioning everything, particularly who you are. Suddenly you are not part of the whole; there is a teenage separation.”

Cuarón added that working with Radcliffe, Watson, and Grint especially marked a turning point in the rising actors’ careers.

“They were becoming more aware of the craft of acting and they wanted to go to the next stage,” Cuarón said. “From the get-go we talked about how we wanted to ground everything, to make it about a normal human experience in this world. [We wanted to explore] the internal life of each one of these characters. They were incredibly intuitive about this, and very receptive.”

In fact, del Toro even helped convince Cuarón to agree to direct “The Prisoner of Azkaban.”

“I speak often with Guillermo [del Toro], and a couple of days after, I said, ‘You know, they offered me this “Harry Potter” film, but it’s really weird they offer me this,'” Cuarón told Total Film. “He said, ‘Wait, wait, wait, you said you haven’t read “Harry Potter”?’ I said, ‘I don’t think it’s for me.’ In very florid lexicon, in Spanish, he said, ‘You are an arrogant asshole.'”

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A charming look at a reader’s many moods

Elisa Gabbert’s essays in “Any Person Is the Only Self” are brimming with pleasure and curiosity about a life with books.

Tell people you read and write for a living, and they picture a ghostly creature, an idea only incidentally appended to a body. What they often fail to understand is that the life of the mind is also a physical life — a life spent lugging irksomely heavy volumes around on the Metro and annotating their margins with a cramping hand. The poet, essayist and New York Times poetry columnist Elisa Gabbert is rare in grasping that reading is, in addition to a mental exercise, a movement performed in a particular place.

“If I remember anything about a book, I also remember where I read it — what room, what chair,” she writes in her charming new essay collection, “ Any Person Is the Only Self .” Writing, too, proves spatial: “I think essays, like buildings, need structure and mood. The first paragraph should function as a foyer or an antechamber, bringing you into the mood.”

The 16 delightfully digressive pieces in this collection are all moods that involve books in one way or another. But they are not just about the content of books, although they are about that, too: They are primarily about the acts of reading and writing, which are as much social and corporeal as cerebral.

In the first essay — the foyer — Gabbert writes about the shelf of newly returned books at her local library. “The books on that shelf weren’t being marketed to me,” she writes. “They weren’t omnipresent in my social media feeds. They were very often old and very often ugly. I came to think of that shelf as an escape from hype.” The haphazard selections on the shelf were also evidence of other people — the sort of invisible but palpable community of readers that she came to miss so sharply during the pandemic.

In another essay, she learns of a previously unpublished story by one of her favorite authors, Sylvia Plath, who makes frequent appearances throughout this book. Fearing that the story will disappoint her, Gabbert puts off reading it. As she waits, she grows “apprehensive, even frightened.”

There are writers who attempt to excise themselves from their writing, to foster an illusion of objectivity; thankfully, Gabbert is not one of them. On the contrary, her writing is full of intimacies, and her book is a work of embodied and experiential criticism, a record of its author’s shifting relationships with the literature that defines her life. In one piece, she rereads and reappraises books she first read as a teenager; in another, she and her friends form a “Stupid Classics Book Club,” to tackle “all the corny stuff from the canon that we really should have read in school but never had.”

Gabbert is a master of mood, not polemic, and accordingly, her writing is not didactic; her essays revolve around images and recollections rather than arguments. In place of the analytic pleasures of a robustly defended thesis, we find the fresh thrills of a poet’s perfected phrases and startling observations. “Parties are about the collective gaze, the ability to be seen from all angles, panoramically,” she writes in an essay about fictional depictions of parties. She describes the photos in a book by Rachael Ray documenting home-cooked meals — one of the volumes on the recently returned shelf — as “poignantly mediocre.” Remarking on a listicle of “Books to Read by Living Women (Instead of These 10 by Dead Men),” Gabbert wonders, “Since when is it poor form to die?”

“Any Person Is the Only Self” is both funny and serious, a winning melee of high and low cultural references, as packed with unexpected treasures as a crowded antique shop. An academic text on architecture, the Austrian poet Rainer Maria Rilke, a rare memory disorder whose victims recall every aspect of their autobiographies in excruciatingly minute detail, “Madame Bovary,” YouTube videos about people who work as professional cuddlers, a psychological study about whether it is possible to be sane in an insane asylum — all these feature in Gabbert’s exuberant essays. She is a fiercely democratic thinker, incapable of snobbery and brimming with curiosity.

Perhaps because she is so indefatigably interested, she gravitates toward writers who see literature as a means of doubling life, allowing it to hold twice as much. Plath confessed in her journals that she wrote in an attempt to extend her biography beyond its biological terminus: “My life, I feel, will not be lived until there are books and stories which relive it perpetually in time.” The very act of keeping a diary, then, splits the self in two.

Plath once insisted that bad things could never happen to her and her peers because “we’re different.” Gabbert asks “Different why?” and concludes that everyone is different: “We are we , not them. Any person is the only self.” But that “only” is, perhaps counterintuitively, not constrained or constricted. Walt Whitman famously wrote that his only self comprised “multitudes,” and Gabbert echoes him when she reflects, “If there is no one self, you can never be yourself, only one of your selves.” And indeed, she is loath to elevate any of her many selves over any of the others. When she rereads a book that she loved in her adolescence, she thinks she was right to love it back then. “That self only knew what she knew,” she writes. “That self wasn’t wrong .” Both her past self and her present self have an equal claim to being Elisa Gabbert, who is too fascinated by the world’s manifold riches to confine herself to a single, limited life.

Becca Rothfeld is the nonfiction book critic for The Washington Post and the author of “All Things Are Too Small: Essays in Praise of Excess.”

Any Person Is the Only Self

By Elisa Gabbert

FSG Originals. 230 pp. $18, paperback.

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All Thing Are Too Small: Essays in Praise of Excess - It all gets a bit too much in the end

Becca rothfeld’s collection is energetic and charmingly verbose, but her tendency to demystify everything wears thin.

Becca Rothfeld: Moments of clear insight and great beauty

Towards the end of All Things Are Too Small, Becca’s Rothfeld’s defence of maximalism, she reproduces a quotation that she has “so thoroughly digested and metabolised” that it is now an essential fixture of her “mental repertoire”.

“I love a demystified thing inordinately.”

Yes, I thought, that’s it. That’s the problem with this book: Rothfeld’s tendency towards such relentless demystification of her subjects that they’re pallid and lifeless by the time she’s through.

This is not true of all the essays in the collection. It opens promisingly and with astounding energy and vigour. Initially, one forgives Rothfeld’s immediately evident habit of making grand, inaccurate statements, such as: “Desire is as good a guide to truth as anything else.” If anything, her verbosity and inexactitude seem charming – she’s wrong because she’s passionate. Reading, I felt myself at a dinner table surrounded by voices stridently debating all manner of interesting things: literature, meaning, mindfulness, feminism, sex, sex and more sex (to give an idea of the topics of these essays).

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My God, though, did I want that dinner to end, so I could return somewhere peaceful and reflective, to cease the ringing in my ears of all this terribly intelligent demystifying. The humour, too, wears thin. Yes, it’s hilarious to mock the bourgeois aesthetic of Marie Kondo (I laughed aloud at “the declutterer dreams of a house without f**king or sh**ting”), but by the end of the collection, these knowing asides and the unremitting sarcasm made me feel like I was trying to converse with a surly, unimpressed teenager.

Also, Rothfeld’s attempts at love-writing made me physically cringe. At one point, she tells us that her husband loves reading so much, he does so in the shower. The impossible logistics of this image will never, I fear, cease to irritate me.

Yet, there are moments of clear insight, and of great beauty. Rothfeld’s capacious vocabulary left me stunned, and exquisite phrases such as “the gleaming purity of a history” almost made up for her agonising attempts at poeticism.

“The night was cool as mint. Behind him, the light from the streetlamp became butter melting. His voice was flat and nasal, mouthy as saltwater toffee.”

Ultimately, this collection’s great weakness is that these pieces have been gathered into a collection at all. I can see that, taken one at a time, Rothfeld’s tone would be pithy and gratifying, and these qualities would make up for her prolix, excessive demystification and broad, questionable statements. Alas, reading her thoughts over and over, all in a row, I grew frustrated, tired and harried. By the end, I wanted to leave the dinner party, to run out into the street, to regain the relief of a little mystery.

IN THIS SECTION

Ross o’carroll-kelly to retire as an author, but not as an irish times columnist, international protection applicant helps rescue woman from river liffey in dublin city centre, fired supervalu worker accused of clocking in and going to sleep, ‘old mr brennan’, founder of family-run irish bread maker, dies, dublin constituency: left-wing candidates face dog fight for the last seat, taoiseach keeping ‘open mind’ on asylum processing in third countries, latest stories, in a word...snapper, fran rooney obituary: poster boy for the dotcom crash who regretted nothing, hazel allen obituary: gifted restaurateur who preferred to remain out of the limelight at ballymaloe, fitch upgrades ireland’s credit rating to highest since 2009.

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The Ethicist

Can i use a.i. to grade my students’ papers.

The magazine’s Ethicist columnist on artificial intelligence platforms, and whether it’s hypocritical for teachers to use these tools while forbidding students from doing the same.

By Kwame Anthony Appiah

I am a junior-high-school English teacher. In the past school year, there has been a significant increase in students’ cheating on writing assignments by using artificial intelligence. Our department feels that 13-year-old students will only become better writers if they practice and learn from the successes and challenges that come with that.

Recently our department tasked students with writing an argumentative essay, an assignment we supported by breaking down the process into multiple steps. The exercise took several days of class time and homework to complete. All of our students signed a contract agreeing not to use A.I. assistance, and parents promised to support the agreement by monitoring their children when they worked at home. Yet many students still used A.I.

Some of our staff members uploaded their grading rubric into an A.I.-assisted platform, and students uploaded their essays for assessment. The program admittedly has some strengths. Most notable, it gives students writing feedback and the opportunity to edit their work before final submission. The papers are graded within minutes, and the teachers are able to transfer the A.I. grade into their roll book.

I find this to be hypocritical. I spend many hours grading my students’ essays. It’s tedious work, but I feel that it’s my responsibility — if a student makes an effort to complete the task, they should have my undivided attention during the assessment process.

Here’s where I struggle: Should I embrace new technology and use A.I.-assisted grading to save time and my sanity even though I forbid my students from using it? Is it unethical for teachers to ask students not to use A.I. to assist their writing but then allow an A.I. platform to grade their work? — Name Withheld

From the Ethicist:

You have a sound rationale for discouraging your students from using A.I. to draft their essays. As with many other skills, writing well and thinking clearly will improve through practice. By contrast, you already know how to grade papers; you don’t need the practice.

What matters is whether an A.I.-assisted platform can reliably appraise and diagnose your students’ writing, providing the explanation and guidance these students need to improve. In theory, such tools — and I see that there are several on the market, including from major educational publishers — have certain advantages. The hope is that they can grade without inconsistency, without getting tired, without being affected by the expectations that surely affect those of us who hand-grade student work.

I notice you haven’t raised concerns about whether the platform provides reliable assessments; you’ll have to decide if it does. (If it isn’t quite up to snuff, it might become so in a year or two, so your question will persist.) Provided the platform does a decent job of assessment, though, I don’t see why you must do it all yourself. You should review the A.I.-annotated versions of your students’ writing, check that you agree with the output, and make notes of issues to bring up in class. But time saved in evaluating the papers might be better spent on other things — and by “better,” I mean better for the students. There are pedagogical functions, after all, that only you can perform.

In sum: It’s not hypocritical to use A.I. yourself in a way that serves your students well, even as you insist that they don’t use it in a way that serves them badly.

Readers Respond

The previous question was from a reader who asked about professional boundaries. He wrote: “I am a retired, married male psychiatrist. A divorced female former patient of mine contacted me recently, 45 years after her treatment ended. Would it be OK to correspond with her by email? Or is this a case of ‘once a patient, always a patient?’”

In his response, the Ethicist noted: “The relevant professional associations tend to have strictures that are specifically about sexual relationships with former patients. … In light of the potential for exploitation within the therapist-patient relationship, these rules are meant to maintain clear boundaries, protect patient welfare, uphold the integrity of the profession and eliminate any gray areas that could lead to ethical breaches. But though you do mention her marital status, and yours, you’re just asking about emailing her — about establishing friendly relations. The question for you is whether she might be harmed by this, whether whatever knowledge or trust gained from your professional relationship would shadow a personal one. Yes, almost half a century has elapsed since your professional relationship, but you still have to be confident that a correspondence with her clears this bar. If it does, you may email with a clear conscience.” ( Reread the full question and answer here. )

As always, I agree with the Ethicist. I would add that the letter writer’s former patient doesn’t realize that the therapist is actually two different people — the professional and the regular person underneath. Therapists portray their professional selves to their clients. The former client may be disappointed upon meeting the therapist outside of the professional context. Additionally, the feelings she has toward the therapist may be based on transference, and they would need to address that. — Annemarie

I am a clinical psychologist. While the Ethicist’s description of professional ethical boundaries is correct, there is more to the story, and I disagree with his conclusion. A very big question here is why this former patient contacted him after 45 years. That is a question that is best explored and answered within the context of a therapeutic relationship. He would be well- advised to respond in a kind and thoughtful way to convey the clear message that he is not available for ongoing communication, and he should suggest that she consult with another therapist if she feels that would be helpful. — Margaret

In my case, it was the therapist who reached out to me, seeking to establish a friendship several years after our sessions ended. I was surprised, but he shared that he had since experienced a similar personal tragedy to one I had explored with him in sessions. Since it had been several years since we saw each other professionally, I responded. There was never any hint of romantic or sexual interest. Still, as he continued to reach out to me, clearly desiring a friendship, it never felt right to me. It did feel unprofessional, as his knowledge of me was borne out of a relationship meant to be professional, never personal, as warmly as we might have felt during our sessions. I ended up being disappointed in him for seeking out my friendship. — Liam

I am a (semi)retired psychiatrist who has been practicing since 1974. In my opinion, “once a patient, always a patient” is correct. Establishing any type of personal relationship with a former patient could undo progress the patient may have made in treatment, and is a slippery slope toward blatantly unethical behavior. As psychiatrists, our responsibility is to work with patients in confronting and resolving issues that are preventing them from having a reality-based perception of their life. With such an outlook, they are more capable of establishing satisfying relationships with others. An ethical psychiatrist is not in the business of providing such satisfaction to his or her patients. — Roger

I think there is a difference between being friendly and being friends with a former client. As someone who used to attend therapy with a therapist I think dearly of, she made it clear to me that it was OK to send her emails with life updates after our therapeutic relationship ended. But beyond that, I think it would be inappropriate and uncomfortable to pursue a friendship with her, and vice versa, because of the patient-provider relationship that we previously had and the power dynamic that existed between us. The letter writer didn’t share the content of the email his former patient sent to him, but if it’s just a friendly life update, I think it’s fine to write back and thank her for sharing. Beyond that, I feel like it would be unprofessional to meet or pursue a deeper relationship. — Meghan

Kwame Anthony Appiah is The New York Times Magazine’s Ethicist columnist and teaches philosophy at N.Y.U. His books include “Cosmopolitanism,” “The Honor Code” and “The Lies That Bind: Rethinking Identity.” To submit a query: Send an email to [email protected]. More about Kwame Anthony Appiah

Author readings around Boston through June 8

All author appearances are in person and free unless otherwise noted.

SUNDAY JUNE 2

• Todd Boss (” The Boy Who Said WOW ”) and Ronan Mattin will host a meet and greet from 1-2 p.m. at Wellesley Books .
• Heather Treseler (“ Auguries and Divinations: Poems ”) and Leslie Williams (” Matters For You Alone ”) will read at 2 p.m. at Newtonville Books .
• Elaine Dimopoulos (” The Perilous Performance at Milkweed Meadow ”) will be in conversation with Julie Bliven at 4 p.m. at Belmont Books .
• Members of the Boston University MFA (Fiction Cohort) Class of 2024 will read their work from 6-8 p.m. at Beacon Hill Books & Cafe .
• Linda Moore (” Five Days in Bogotá ”) will be in conversation with Randy Susan Meyers and sign copies of her book at 7 p.m. at Hummingbird Books (Tickets are $22, include a copy of the book.)

MONDAY JUNE 3

• Talmage Boston (” How the Best Did It: Leadership Lessons from Our Top Presidents ”) will discuss his book at 6 p.m. at Boston Athenaeum (Tickets are free for members. In-person general admission tickets are $10, waitlist only; virtual tickets are $5.)
• Alice Wong (” Disability Intimacy: Essays on Love, Care, and Desire ”) will be in conversation with Leah Lakshmi Piepzna-Samarasinha, Nicole Lee Schroeder, and Ellen Samuels virtually at 6 p.m. through Harvard Book Store (Registration is required.)
• Michael Ponsor (” Point of Order ”) will discuss his book at 7 p.m. at Harvard Book Store .
• Maurice Vellekoop and Cathy G. Johnson will discuss the intersection of queerness and pop culture at 7 p.m. at Aeronaut Brewing (Registration is requested, event is 21+.)
• Morgan Talty (” Fire Exit ”) will be in conversation with Michelle Ajodah at 7 p.m. at Porter Square Books (Registration is requested.)
• Dr. Lisa Mosconi (” The Menopause Brain ”) will be in conversation with Dr. Alana Franklin and sign copies of her book at 7 p.m. at Hummingbird Books (Tickets are $35, include a copy of the book.)

TUESDAY JUNE 4

• Percival Everett (” James ”) will be in conversation with Kim McLarin at 6 p.m. at Coolidge Corner Theatre (Tickets are $15.50.)
• Dr. Karen Tang (” It’s Not Hysteria: Everything You Need to Know About Your Reproductive Health (But Were Never Told) ”) will be in conversation with Schuyler Bailar at 6:30 p.m. at Cambridge Public Library (Registration is required.)
• Linda Humphrey and Maria Lenhart (” Secret Cape Cod and Islands: A Guide to the Weird, Wonderful, and Obscure ”) will discuss their book at 6:30 p.m. at the Sandwich Public Library (Registration is required.)
• Kellie Carter Jackson (”We Refuse: A Forceful History of Black Resistance”) will be in conversation wtih Dr. Kerri Greenidge at 6:30 p.m. at the Museum of African American History .
• Kathleen Collins (” Study in Hysteria ”) will be in conversation with Andrea Volpe at 7 p.m. at Belmont Books .
• John Kaag (” American Bloods: The Untamed Dynasty That Shaped a Nation ”) will discuss his book at 7 p.m. at the Concord Museum (Tickets are free for members, $10 for nonmembers.)
• Sara B. Franklin (” The Editor: How Publishing Legend Judith Jones Shaped Culture in America ”) will be in conversation with Kathy Gunst at 7 p.m. at Harvard Book Store .
• Sara Shukla (” Pink Whales ”) will be in conversation with Jane Roper at 7 p.m. at Porter Square Books: Boston Edition (Registration is requested.)
• Kate Messner and Rajani LaRocca (” The Kids in Mrs. Z’s Class ”) will discuss their books at 7 p.m. at The Silver Unicorn Bookstore .
• Freddie Kölsch (” Now, Conjurers ”) will be in conversation with Cat Scully and Erica Waters at 7 p.m. at Copper Dog Books (Registration is requested.)

WEDNESDAY JUNE 5

• Dr. Kerri Greenidge (” The Grimkes: The Legacy of Slavery in an American Family ”) will discuss her book at noon at the State Library of Massachusetts .
• Jessica Shattuck (” Last House ”) will be in conversation with Rebecca Donner at 6 p.m. at Beacon Hill Books & Cafe (Registration is requested.)
• Ann Leary (” I’ve Tried Being Nice: Essays ”) will be in conversation with Denis Leary and Beth Teitell at 6 p.m. at Cambridge Public Library (Registration is required.)
• Chris Colfer (” Roswell Johnson Saves the World! ”) will be signing copies of his book from 6:30-8:30 p.m. at Porter Square Books: Boston Edition (Tickets are $20.18, include a copy of the book. Tickets either accommodate one adult or one adult + one child.)
• : Heather Treseler (” Auguries & Divinations Poems ”) will read at 7 p.m. at Grolier Poetry Book Shop (In-person tickets start at $5, virtual tickets are pay what you want.)
• Chukwuebuka Ibeh (” Blessings ”) will be in conversation with Zoë Gadegbeku at 7 p.m. at Harvard Book Store .
• Simon Van Booy (” Sipsworth ”) will be in conversation with Margot Livesey at 7 p.m. at Porter Square Books (Registration is requested.)

THURSDAY JUNE 6

• KJ Micciche (” A Storybook Wedding ”) and Kristan Higgins (” Look on the Bright Side ”) will read and sign copies of their books at 6 p.m. at Beacon Hill Books & Cafe (Registration is requested.)
• Sarah Boyer (”Coming Out, Becoming Ourselves: Lesbian Stories from the Boston Daughters of Bilitis, 1969-1999”) will discuss her book at 6 p.m. at Boston Public Library Jamaica Plain branch .
• Dr. R. Tripp Evans (” The Importance of Being Furnished: Four Bachelors at Home ”) will discuss his book virtually at 6 p.m. through The Gibson House Museum (Tickets are $10.)
• Nick Bruel (” Bad Kitty Makes a Movie ”) will discuss and sign copies of his book and host a drawing demonstration at 6:30 p.m. at An Unlikely Story (Tickets are $5.)
• TJ Alexander (” Triple Sec ”) will discuss their book at 7 p.m. at Upstairs @ Bow (Tickets are $27.18, include a copy of the book. Cocktails and mocktails will be served.)
• Emily Habeck (” Shark Heart: A Love Story ”) will be in conversation with Sofia Romero at 7 p.m. at Brookline Booksmith (Registration is requested.)
• Garth Risk Hallberg (” The Second Coming ”) will be in conversation with J. Courtney Sullivan at 7 p.m. at Harvard Book Store .
• Wei Tchou (” Little Seed ”) will be in conversation with Emma Hunsinger at 7 p.m. at Porter Square Books (Registration is requested.)
• Ann Leary (” I’ve Tried Being Nice: Essays ”) will discuss her book at 7 p.m. at Wellesley Books (Tickets are $5.)
• Jonathan Wilson (” The Red Balcony ”) will be in conversation with Amy Dockser Marcus at 7 p.m. at Newtonville Books .

FRIDAY JUNE 7

• Margot Livesey (” The Road from Belhaven ”) will be at Beacon Hill Books & Cafe for a meet and greet and book signing from 12-2 p.m.
• noam keim (” The Land Is Holy ”) will be in conversation with Hanif Abdurraqib virtually at 7 p.m. through Brookline Booksmith (Virtual, registration is required.)
• Keith O’Brien (” Charlie Hustle ”) will be in conversation with Alex Speier at 7 p.m. at The Silver Unicorn Bookstore .

SATURDAY JUNE 8

• Heather Lang and Jamie Harper (” Superdads! Animal Heroes ”) will read at 11 a.m. at The Silver Unicorn Bookstore .
• Poet M. Shahid Alam (”Yardstick of Life”) will read and sign copies of his work at 1:30 p.m. at Frugal Bookstore .
• Mary Kilroy (”Up the House: Old Colony Housing Project South Boston 1944-1954″) will discuss her book at 2 p.m. at Boston Public Library South Boston branch (Registration is required.)
• Desmond Hall (” Better Must Come ”) and Rachel Lynn Solomon (” Past Present Future ”) will be in conversation with Jenny L. Howe at 7 p.m. at Brookline Booksmith (Registration is requested.)